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Danger lurks under the knife

By Michael Day

SCALPEL-happy surgeons and doctors who fail to prescribe drugs to
patients undergoing operations are raising the death rate in British hospitals,
says a survey published this week.

The National Confidential Enquiry into Perioperative Deaths (NCEPOD) raises
the concern that many deaths from blood clots and septicaemia following surgery
are preventable, and that some elderly patients are having operations when they
are so weak they are unlikely to survive surgery. Over 20 000 post-operative
deaths in England, Wales and Northern Ireland, from April 1993 to March 1994
were reported to NCEPOD. The enquiry studied detailed anonymous questionnaires
filled in by doctors relating to 2000 of these deaths.

NCEPOD clinical co-ordinator Ron Hoile, a consultant surgeon at the Medway
Hospital in Gillingham, Kent, claims that many doctors are breaching agreed
guidelines for treatment. “Some emergency cases don’t always get the treatment
laid down in protocols,” he says. Hoile says that many doctors fail to prescribe
antibiotics to surgery patients to prevent infection. Many women, at high risk
of suffering deep vein thromboses after surgery, are not treated with
anticoagulant drugs, he adds.

The report also highlights the high death rates of elderly patients with
fractured femurs. Of the 422 deaths after surgery for this condition analysed in
the survey, one in seven patients had died within a day of the
operation—which suggests to Hoile that the patients were too frail to go
under the knife. “It’s a bit like surgical euthanasia,” he argues.

“There is an unwritten, possibly unsubstantiated, doctrine, that every
patient should be operated on to achieve pain relief and ease nursing care. This
needs to be reconsidered,” the report concludes.